Salicylate poisoning

Salicylate poisoning after ingestion of ≥125 mg/kg salicylate, ingestion of any amount of methyl salicylate, or, rarely, topical exposure is potentially fatal. Patients can present acutely after accidental or intentional overdose. Chronic exposure to too much salicylate is an important, but difficult, diagnosis.

Consider salicylate poisoning in any patient presenting with a history of unknown toxin ingestion or exposure, particularly in the presence of an unexplained acid-base disturbance. Consult the local poison control centre and/or toxicologist early.

Clinical presentation, salicylate levels, and acid-base status direct treatment decisions.

There is no antidote for salicylate poisoning. Management is supportive and may involve treating dehydration, hyperthermia, hypokalaemia, or convulsions. Activated charcoal may be considered if the patient presents within 1 hour of poisoning; urinary alkalinisation is also a treatment option depending on plasma salicylate concentration.

Emergency haemodialysis is recommended for patients with very high plasma salicylate levels or symptoms particularly associated with severe poisoning.

Salicylate poisoning is the result of ingestion of, or (rarely) topical exposure to, chemicals metabolised to salicylate.[1]Palmer BF, Clegg DJ. Salicylate toxicity. N Engl J Med. 2020 Jun 25;382(26):2544-55. http://www.ncbi.nlm.nih.gov/pubmed/32579814?tool=bestpractice.com Poisoning may occur because of acute or chronic salicylate exposure and is characterised by acid-base disturbances, electrolyte abnormalities, and central nervous system effects.[1]Palmer BF, Clegg DJ. Salicylate toxicity. N Engl J Med. 2020 Jun 25;382(26):2544-55. http://www.ncbi.nlm.nih.gov/pubmed/32579814?tool=bestpractice.com The most common source of salicylate poisoning is aspirin (acetylsalicylic acid), which is rapidly hydrolysed to salicylate in the gastrointestinal tract, liver, and bloodstream. Acute toxicity may occur in adults and children after ingestion of ≥125 mg/kg salicylate.[2]National Poisons Information Service. TOXBASE®: salicylic acids and salicylates (salicylates). May 2019 [internet publication]. https://www.toxbase.org/Poisons-Index-A-Z/S-Products/Salicylates Chronic poisoning tends to occur after repeated exposure to high-dose aspirin, particularly in people with renal insufficiency.[1]Palmer BF, Clegg DJ. Salicylate toxicity. N Engl J Med. 2020 Jun 25;382(26):2544-55. http://www.ncbi.nlm.nih.gov/pubmed/32579814?tool=bestpractice.com